Inside the Beltway

Why Healthcare Should Matter to Scientists

by Michael S. Lubell, APS Director of Public Affairs

The House of Representatives has already voted to abolish the Affordable Care Act 41 times. And if there were enough legislative days remaining before the end of the 2013 session, the anti-Obamacare zealots would probably do it 41 more times.

But masked by the partisan attacks on the president's signature program is an uncomfortable truth that most Americans don't want to hear: unless healthcare costs stop rising faster than inflation, wages will continue to stagnate and discretionary federal spending will be squeezed into a thimble.

Frank Wolf (R-VA), chairman of the House Commerce Justice and Science Appropriations Subcommittee, is a staunch supporter of the National Science Foundation and the National Institute of Standards and Technology, both of which fall under his subcommittee's jurisdiction. But he has warned repeatedly that unless mandatory spending is held in check, his subcommittee's ability to fund science will be increasingly constrained.

Without question, Wolf's admonition is correct, but by pointing his finger at the three big budget busters (Social Security, Medicare and Medicaid) he is giving a pass to the real culprit: the extraordinary cost of American medicine.

Social Security, it turns out, is not too difficult to fix, at least in principle. The 2012 Social Security Trustees Report provides a number of possible scenarios, including one I find particularly appealing: raising the inflation-adjusted wage base, currently $113,700, to capture a greater share of America's rapidly growing income disparity.

You may find other approaches more acceptable, including President Obama's proposal to use the "chained Consumer Price Index" to adjust benefits for inflation. But in the end, we should all reach the same conclusion: Social Security does not have to be a budget buster.

Healthcare is another matter. Constraining Medicare and Medicaid spending at a time when our population is aging rapidly is a herculean task. In fact, without a clampdown on the costs of medicine, not even Harry Houdini would be able to escape the inevitable bind.

It's time for every American to begin to ponder why we spend almost twice as much per capita on healthcare as France — rated No. 1 in the world by the World Health Organization — and see poorer outcomes. And, absent transformations of the American landscape, it's time for physicists to ponder whether the next generation of scientists will be better off seeking employment in Europe or Asia, where healthcare costs are not choking off research spending and where future jobs may be more plentiful.

Scientists must take Frank Wolf's admonition seriously that federal research support will erode in the face of increasing federal commitments to Medicare and Medicaid. But they must also take seriously the impact of Medicaid spending at the state level.

Begun as part of Lyndon Johnson's "Great Society" initiative in 1965, Medicaid has been encroaching for more than four decades on public support of higher education across the country. The Kaiser Family Foundation's 2011 report, "Update: State Budgets in Recession and Recovery," highlights the impact.

In 2009, according to Kaiser, Medicaid consumed an average of more than 15 cents of every state dollar allocated to general fund expenditures. And in 23 states Medicaid disbursements surpassed spending on higher education.

The higher education budget vise has had dramatic impacts, and as you may imagine, none of them good. The cost of college tuition has increased dramatically, student debt has soared and a four-year bachelor's degree program has often become an eight-year slog.

Today, public universities are under pressure from Washington and state capitals to limit tuition increases, enhance student enrollment, promote student retention, reduce time to graduation and boost faculty instructional productivity. It's hard to argue with the lofty goals, but achieving them may come at a number of costs, especially to science.

Less institutional support for research infrastructure, fewer credit requirements for graduation, higher teaching loads, closure of undersubscribed programs and potentially lower academic standards may be on the horizon. And they are all inimical to sustaining high-quality research and STEM education in public universities.

For more than half a century, America's colleges and universities have been the envy of the world, especially in science. Paring back the public component under the inexorable pressure of rising costs of medicine is coming now just as the rest of the world has caught up.

In a highly competitive and mobile global scientific enterprise, it is imperative that American policy makers face up to a reality: to keep America at the cutting edge of research will require making America competitive in healthcare costs. Obamacare may deliver insurance for the uninsured, but if it doesn't lower the costs of medical treatment and drugs, it will fail to provide a viable path for continued excellence of American science.